Heper Y, Akalin E H, Mistik R, Akgöz S, Töre O, Göral G, Oral B, Budak F, Helvaci S
Faculty of Medicine, Microbiology and Infectious Diseases Department, Uludag University, Görükle, 16059 Bursa, Turkey.
Eur J Clin Microbiol Infect Dis. 2006 Aug;25(8):481-91. doi: 10.1007/s10096-006-0168-1.
The diagnostic value of procalcitonin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-10 levels in differentiating sepsis from severe sepsis and the prognostic value of these levels in predicting outcome were evaluated and compared in patients with community-acquired sepsis, severe sepsis, and septic shock in the first 72 h of admission to the hospital. Thirty-nine patients were included in the study. The severe sepsis and septic shock cases were combined in a single "severe sepsis" group, and all comparisons were made between the sepsis (n=21 patients) and the severe sepsis (n=18 patients) groups. Procalcitonin levels in the severe sepsis group were found to be significantly higher at all times of measurements within the first 72 h and were significantly higher at the 72nd hour in patients who died. Procalcitonin levels that remain elevated at the 72nd hour indicated a poor prognosis. C-reactive protein levels were not significantly different between the groups, nor were they indicative of prognosis. No significant differences in the levels of tumor necrosis factor-alpha were found between the sepsis and severe sepsis groups; however, levels were higher at the early stages (at admission and the 24th hour) in patients who died. Interleukin-10 levels were also higher in the severe sepsis group and significantly higher at all times of measurement in patients who died. When the diagnostic and prognostic values at admission were evaluated, procalcitonin and interleukin-10 levels were useful in discriminating between sepsis and severe sepsis, whereas tumor necrosis factor-alpha and interleukin-10 levels were useful in predicting which cases were likely to have a fatal outcome.
对社区获得性脓毒症、严重脓毒症和脓毒性休克患者入院后最初72小时内降钙素原、C反应蛋白、肿瘤坏死因子-α和白细胞介素-10水平在区分脓毒症与严重脓毒症方面的诊断价值以及这些水平在预测预后方面的价值进行了评估和比较。本研究纳入了39例患者。严重脓毒症和脓毒性休克病例合并为一个“严重脓毒症”组，所有比较均在脓毒症组（n = 21例患者）和严重脓毒症组（n = 18例患者）之间进行。发现严重脓毒症组降钙素原水平在最初72小时内的所有测量时间均显著更高，且在死亡患者的第72小时显著更高。第72小时降钙素原水平持续升高表明预后不良。两组间C反应蛋白水平无显著差异，也不能指示预后。脓毒症组和严重脓毒症组之间肿瘤坏死因子-α水平无显著差异；然而，死亡患者在早期（入院时和第24小时）水平更高。严重脓毒症组白细胞介素-10水平也更高，且在死亡患者的所有测量时间均显著更高。当评估入院时的诊断和预后价值时，降钙素原和白细胞介素-10水平有助于区分脓毒症和严重脓毒症，而肿瘤坏死因子-α和白细胞介素-10水平有助于预测哪些病例可能有致命结局。
